tlc for ltc module four - perelman school of medicine at ... · tlc for ltc delaware valley...

Module Four

Teaching and Learning to Care:

Training for Caregivers in Long Term Care

TLC for LTC

When the Mind Falters:Cognitive Losses in Dementia

by

Joel Streim, MDAssociate Professor of Psychiatry

Director, Geriatric Psychiatry Fellowship ProgramUniversity of Pennsylvania

VISN 4 Mental Illness Research Education and Clinical CenterPhiladelphia VA Medical Center

for

Delaware Valley Geriatric Education CenterInstitute on Aging

University of Pennsylvania

Supported by a grant from the Health Resources and Services AdministrationBureau of Health Professions

United States Department of Health and Human Services

Module Four: When the Mind Falters: Cognitive Losses in Dementia

TLC for LTC Delaware Valley Geriatric Education CenterUniversity of Pennsylvania i

© 2002 University of PennsylvaniaPermission is granted to copy participant materials under Tab 3.

Institute on AgingUniversity of Pennsylvania3615 Chestnut St.Philadelphia, PA 19104215-573-7293


TLC for LTC Delaware Valley Geriatric Education CenterUniversity of Pennsylvania

Acknowledgements

Appearing in Video:

Name Appearing as

Charles Hicks...........................................................Resident

Barbara Hicks..........................................................Resident

Cara Nealon...............................................................CNA

Special thanks to:

Lorrie Goss, RNC, Director of Nursing, Pennswood Village, for coordination ofvideo shoot.

Pennswood Village for permitting video production.

ii



iii



Table of Contents

Tab 1. Presentation Materials for the InstructorIntroductionForms for administration at start of moduleInstructional materialsForms for administration at end of moduleReference List

Tab 2. Handout Materials for the Participants to Use and Keep

Introduction to Module and ObjectivesHandout version of presentationOptional additional materials

TLC for LTC Delaware Valley Geriatric Education CenterUniversity of Pennsylvania Tab 1-6




Tab 1. Presentation Materials for the Instructor

Introduction

Why this Module?

Dementia, and the cognitive losses and behavioral changes it causes, presents majorchallenges to nursing home staff. With an improved understanding of how cognitionbecomes impaired and the stages of dementia, direct care staff can better assessresidents’ abilities and issues, and respond to them appropriately. The loss of mentalfunction and behavioral changes caused by dementia are frequent reasons for nurs-ing home admission. As a result, up to two-thirds of nursing home residents havedementia. Approximately 70% of those persons are though to have dementia withAlzheimer’s disease. Dementia is a major health problem in the U.S., with over 4million cases. Epidemilogical studies have shown that up to 8% of al individuals over65 have Alzheimer’s disease. For those living beyond age 80, studies suggest thatsomewhere between a quarter and half are affected by Alzheimer’s disease.

What is the content?Key content for you to teach in this modules includes:1. The Early, Middle and Late Stages of Dementia

EARLY STAGES:People show signs of forgetfulness, confusion, word-finding difficulty, repitition, and/or poor problem-solving.People need supervision for instrumental activities of daily living (IADLs) e.g.,household management.

MIDDLE STAGES:People show signs of poor recent and remote memory, disorientation, difficultyspeaking full sentences, inability to recognize familiar people, and/or difficulty ma-nipulating objects.People need assistance to perform basic activities of daily living (BADLs) e.g., per-sonal care.Behavioral problems are common.

LATE STAGES:People show signs of difficulty speaking, walking, sitting up, and/or eating. Peopleneed assistance in all ADLs; progression to total care.

Tab 2-2



2. The cognitive problem dementia causes:Use of language or aphasia.Visual-spatial funtion or perceptual confusionRecognition or agnosiaMotor coordination or apraxiaPerforming sequential tasks or executive dysfuntion

The technical terms are included because staff may hear them and will be able to recog-nize them. They are not expected to learn them.

3. Why and how to recognize disabilities and residual abilities: Disabilities need compen-sation; residual abilities should be supported.

4. Why periodic assessments are important: To detect changes in the affected person’sneeds and any reversible declines.

What Are the Learning Objectives?

At the end of this module, direct care staff will be able to:

Describe the stages of dementiaDistinguish between specific cognitive impairments resulting fromdementiaLink specific cognitive impairments with the disabilities they causeGive examples of cognitive impairments and disabilitiesDescribe what to do when there is an acute change in cognitive or functionalstatus

What Key Concepts Should Be Covered?

Be sure to address at least the following:Why understanding dementia is important (dementia is common; it isespecially important to be aware of its progression, specific impairments, and disabilties so that staff can offer quality care).Stages of dementiaCauses of dementiaCognitive problems caused by dementiaDisabilities associated with cognitive impairmentDistinguishing temporary symptoms of dementia from expectedprogression

Tab 2-3



Tab 2-4

How to Use this Module:

The component elements are described in the order in which they appear in thebody of the module.

Attendance Form which can be duplicated for your use

Pretest, a brief test of True/False and multiple choice items. You should havesufficient copies for presenter and participants. An Instructor version with cor-rect answers is supplied and test-scoring instructions appear with the test.

Your presentation materials include:Overhead transparencies for projection.A paper copy of the overheads with notes about the content for your usein teaching from the overheadsA videotape is available through the DVGEC. The videotape segment forthis module should be shown either before of after overhead 11 or afteroverhead 14 (the overheads showing examples). The video can serveeither as an orientation to this set of slides or as a review. The videoillustrates common impariements resulting frm loss of cognitive function.

Note: If there is more content than you can teach in the time available, consultwith your staff development educator to select ahead of time what will be cov-ered.

Participant Post-test wich is identical to the Pre-test but with the items in differ-ent order and with a “Post Test” heading. Have participants use the same identi-fier as on the Participant Pre-test so you can match pre-post scores.

Program Evaluation form for completion by participants.

Program Evluation form for completion by instructor.

Before Your Presentation:Review all materials, pay special attention to the objectives, key conceptsand test items.

PRACTICE presenting the content using the overhead transparencies and theInstructor Notes. We suggest you practice the presenation two ways:1.) straight through to make sure your presentation is consistent with theavailable time, and 2.) pausing to practice when you feel dissatisfied with youryour delivery of content.

Make sure you have sufficient copies of tests and handouts.

Suggestion: Put transparencies in a small binder for presentation -- keepsthem in order and allows instructor to flip through them. Likewise put theinstructor notes in a binder to facilitate presentation.

At the Time of Your Presentation:

After introductions, distribute the Participant Pre-test. Have participants put anidentification code (like your mother’s first name) on the test so that you canmatch pre-and post test scores, then collect completed tests.Put the facility name and the date on the Attendance Sheet and have participantssign it.Make presentation using transparencies and the Instructor version with notes.Follow instructions with the last two slides for showing and discussion of the video.Have participants complete Post-test using the same identification code.Have participants complete the Participant Evaluation form.

After Your Presentation:

Please complete the Instructor Evaluation form.Score Pre-and Post-tests using form provided.Return scored tests, completed evaluation forms and instructional materials toyour staff development educator.




Attendance Form

Facility Name: _____________________________________________

Date: ___________________________________________________

Tab 2-7

emaN eltiT/noitisoP )ynafi(eergeD

Tab 2-8




Tab 2-9

Your ID ____________ Today’s Date _ _/ _ _/ _ _

1. Approximately two-thirds of all nursing home residents T Fhave dementia.

2. Stroke is the most common cause of dementia. T F

3. There is currently no cure for any of hte illnesses T Fthat can cause dementia.

4. Alzheimer’s disease leads to death of brain cells. T F

5. Persons with Alzheimer’s disease may live as T Flong as 15 years after the disease begins.

6. Ability to perform activities of daily living iscompletely lost when a patient develops dementia. T F

7. In the middle stages of Alzheimer’s disease, a person T Fmay be able to dress him/herself, even though he/shecan’t remember where his/her clothes are kept.

Participant Pre-Test

Circle T if the statement is True, F if the statement is false.

Example: This is a test. T F



Tab 2-10

Example:Which of these is NOT a season:a. Winterb. Autumnc. Summerd. Eastere. Spring

8. Apraxia due to dementia may cause problems with:a. Speaking in sentencesb. Pulling a zipperc. Sleeping through the nightd. Executing motor taskse. Any of the above

9. Persons with dementia can have problems with:a. Recognitionb. Speechc. Memoryd. Executing motor taskse. Any of the above

Circle the letter of the best answer.

Participant Pre-Test: Instructor’s KeyCorrect answers are in Circled bold italic









1.









.6. Stroke is the most common cause of dementia. T F


Participant Post - TestCircle T if the statement is True, F if the statement is false.

Example:This is a test. T F




.





Participant Post - Test: Instructor’s KEYCircle T if the statement is True, F if the statement is false.

Example:This is a test. T F






.6. Stroke is the most common cause of dementia. T F




Please circle the best response. Example: Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

1. I can describe the stages of dementia.Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

2. I can now distinguish among specific cognitive impairments from dementiaStrongly Disagree Disagree Agree Strongly Agree

1 2 3 4

3. I can link specific cognitive impairments with the disabilities they cause.Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

4. I can describe what to do when there is an acute chagne in cognitive orfunctional status.Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

5. This program will help me in my care of older adults.Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

6. This program will help me work better with other staff.Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

7. Overall I rate this program:Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

8. Overall I rate this instructor:Strongly Disagree Disagree Agree Strongly Agree

1 2 3 4

9. This program would be better if:

Tab 2-47

Facility _____________Instructor _______________Date: _ _ / _ _ / _ _Participant Evaluation




Tab 2-48



Instructor Evaluation

Please circle the best response: (e.g. Agree )

1. Objectives for this module were appropriate.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

2. This module was well-designed to meet its objectives.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

3. Instructor materials for this module were easy to use.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

4. The content of this module was at the right level for participants.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

5. The videotape for this module helped to meet the objectives.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

6. As an instructor, I rate this module overall as:Poor Fair Good Excellent 1 2 3 4

7. This module would be better if:

Instructor information:

My most advanced degree is: Masters in ________, Bachelors in _______,Associate Degree in __________.

I have been teaching in long-term care for ____ years, _______ months.My current title is: _____________

Please return to Staff Development Educator.Thank you for your participation!

Facility _____________Instructor _______________Date: _ _ / _ _ / _ _

Tab 2-49



Tab 2. Materials for Participants

Handout: When the Mind Falters:Cognitive Losses in Dementia

Why this module?Dementia and the cognitive losses and behavioral changes it causes presents majorchallenges to the direct care staff in geriatrics settings. In this module we will look atways to better understand how cognition becomes impaired, as well as the variousstages of dementia.

What should you learn in this module?OVERALL OBJECTIVE: You will understand the stages of dementia and the symp-toms of each stage. You will also learn to be able to better assess the issues andabilities of affected persons, and respond to them appropriately.

SPECIFIC OBJECTIVES: You will be able to:

1. Describe the early, middle and late stages of dementia.2. Describe the differences among specific cognitive (mental) impairments caused by

dementia.3. Link specific cognitive impairments with the disabilities they cause.4. Give examples of cognitive impairments and disabilities.5. Describe what to do when you notice a sudden change in cognitive status or in abil-

ity to care for oneself.

Cognitive Losses in Dementia: What you need to know?

1. Dementia is common and is a frequent reason for nursing home admission.2. Dementia progresses through early, middle and late stages; at each stage, affected

persons have more significant cognitive problems and greater needs for assistance.3. Dementia is caused by Alzheimer’s disease in about 70% of cases.4. Dementia is sometimes caused by reversible conditions, so careful assessment is

important to identify treatable illnesses.5. Cognitive problems associated with each stage of dementia includes problems in use

of language, perception of space, recognition, motor coordination and performingstep-by-step tasks.

6. Quality care for dementia means assisting individuals to make up for disabilities,but recognizing and supporting them in doing all that they are still able to do.

7. It is important to re-assess persons with dementia regularly, so changes in theircapabilties and needs are detected.

Tab 3-1



Participant Forms: Instructions

We ask for your cooperation in completing the attached formsthat allow us to meet the reporting requirements of the federalgovernment and are helpful in evaluating this module for futureuse. Included are:

1. Participant Profile form: answer the best you can even ifsome items seem confusing. This form asks for identifyinginformation, but will be kept separate from the others.

2. Participant Pre-test: before you begin to participate in thetraining, answer this brief set of questions. When you completethe post-test at the end, you’ll see how much you’ve learned.At the top, write in a word or number that only you will recognizeas identification, then use it again on the post test.

3. Participant Post-test: After the presentation is complete,answer the questions again. Be careful, they are in a differentorder.

4. Participant Evaluation form: Results from this form willbe sent back to us at the Delaware Valley Geriatric EducationCenter. Please help us evaluate the program.

Note to Instructors:1. These forms which you saw first in Tab 2 are included again here to make iteasier for you to make copies.

2. Participants are given instructions above, so that latecomers can completethe paperwork without interrupting the program.

3. Please have participants complete the pre-test BEFORE you give them theirhandout.

Thank you for your cooperation in seeing that these forms are completed.

Tab 3-18



1. Approximately two-thirds of all nursing home residentshave d dementia. T F


3. There is currently no cure for any of the illnesses that cancause dementia. T F


5. Persons with Alzheimer’s disease may live as long as 15 yearsafter the disease begins. T F

6. Ability to perform activities of daily living is completely lostwhen a patient develops dementia. T F

7. In the middle stages of Alzheimer’s disease, a person may beable to dress him/herself, even though he/she can’tremember where his/her clothes are kept. T F

8. Apraxia due to dementia may cauase problems with: (circle thebest answer)

a. Speaking in sentencesb. Pulling a zipperc. Sleeping through the nightd. Hearing voicese. Seeing colors

9. Persons with dementia can have problems with: (circle the best answer)a. Recognitionb. Speechc. Memoryd. Executing Motor Taskse. Any of the above


Example: This is a test. T F

Tab 3-22

Your ID________ Today’s Date __/__/__

Participant Pre-Test


Your ID __________ Today’s Date __/__/__

Tab 3-23

Circle T if the statement is True, F if the statement is false.Example:This is a test. T F

1. Persons with Alzheimer’s disease may live as long as 15 yearsafter the disease begins.. T F

2. There is currently no cure for any of the illnesses that cancause dementia. T F

3. Ability to perform activities of daily living is completely lost when a patient develops dementia . T F

4. Approximately two-thirds of all nursing home residentshave dementia. T F

5. In the middle stages of Alzheimer’s disease, a person may beable to dress him/herself, even though he/she can’tremember where his/her clothes are kept. T F


7. Alzheimer’s Disease leads to death of brain cells T F

8. Persons with dementia can have problems with: (circle the best answer)a. Recognitionb. Speechc. Memoryd. Executing Motor Taskse. Any of the above

9. Apraxia due to dementia may cause probems with:a. Speaking in sentencesb. Pulling a zipperc. Sleeping through the nightd. Hearing voicese. Seeing colors

Module Four: When the Mind Falters: Cognitive Losses in De-mentia

Participant Post-Test



Tab 3-24



Participant Evaluation

Please circle the best response: (e.g. Agree )

1. I can describe how behavior is a form of communicationStrongly Disagree Disagree Agree Strongly Agree 1 2 3 4

2. I can describe strategies for understanding and responding to behaviors ofnursing home residents.

Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

3. I can identify factors in the resident’s life, environment and currentsituation that may affect their behavior.

Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

4. This program will help me in my care of residents.Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

5. This program will help me work better with other staff .Strongly Disagree Disagree Agree Strongly Agree 1 2 3 4

6. Overall I rate this programPoor Fair Good Excellent 1 2 3 4

7. Overall I rate this instructorPoor Fair Good Excellent 1 2 3 4

8. This program would be better if:

Thank you for your participation!

Facility _____________Instructor _______________Date: _ _ / _ _ / _ _

Tab 3-25

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